Descemet membrane endothelial keratoplasty (DMEK) is a corneal transplantation procedure that enables a one-for-one replacement of a diseased Descemet membrane and endothelium complex (see Melles G R, et al. Cornea. 2002; 21:415-418; Melles G R, et al. Cornea. 2006; 25:987-990; and Price M O, et al. Int Ophthalmol Clin. 2010; 50:137-147). DMEK may provide improved post-operative visual outcomes, faster recovery times, and reduced rates of rejection compared to other endothelial keratoplasty procedures such as Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) (see Hamzaoglu E C, et al. Ophthalmology. 2015; Anshu A, et al. Ophthalmology. 2012; 119:536-540; Guerra F P, et al. Ophthalmology. 2011; 118:2368-2373; Tourtas T, et al. Am J Ophthalmol. 2012; 153:1082-1090 e1082; Guerra F P, et al. Cornea. 2011; 30:1382-1386; and Ham L, et al. Arch Ophthalmol. 2009; 127:252-255). While DSAEK and PK remain the most widely performed corneal transplant procedures worldwide, DMEK is steadily gaining ground on these and other surgical procedures in the United States (see Eye Bank Association of America. 2016 Eye Banking of America Statistical Report. Washington D.C.: Eye Bank Association of America; 2017).
With DMEK gaining popularity among surgeons, eye banks have developed internal processing programs to assist surgeons in preparing DMEK grafts (see Eye Bank Association of America. 2016 Eye Banking of America Statistical Report. Washington D.C.: Eye Bank Association of America; 2017; Holiman J, et al. In: Mohit Parekh.; Stefano Ferrari D P, ed. Eye Banking: Nova Biomedical; 2015:123-139; Deng S X, et al. Am J Ophthalmol. 2015; 159:590-596; and Terry M A, et al. Cornea. 2015; 34:845-852). Eye bank prepared pre-stripped tissues can help reduce both time in the operating room (OR) and potential complications that may arise if tissue preparation fails during surgery. Pre-stripped tissues can also provide an additional level of quality assurance as eye banks can perform post-processing evaluation of grafts using tissue evaluation instruments and methods, such as, specular microscopy, slit-lamp biomicroscopy, light microscopy, and/or optical coherence tomography, which are not typically performed in the OR. In the United States, the current Eye Bank Association of America (EBAA) Medical Standards (see Eye Bank Association of America. 2016 Medical Standards. Washington D.C.: Eye Bank Association of America; 2016) require that all eye bank prepared grafts be evaluated by specular microscopy and slit-lamp biomicroscopy.